Efficacy of transjugular intrahepatic portosystemic shunt combined with gastroesophageal variceal embolization in the treatment of 18 cases of gastric fundal varices associated with a gastrorenal shunt
10.3760/cma.j.issn.0254-1432.2015.11.006
- VernacularTitle:经颈静脉肝内门体静脉分流术联合食管胃底曲张静脉栓塞术治疗门静脉高压胃底静脉曲张伴胃肾分流18例的疗效
- Author:
Qin JIANG
;
Mingquan WANG
;
Guobing ZHANG
;
Bin SUN
;
Qiong WU
;
Jianming XU
;
Derun KONG
- Publication Type:Journal Article
- Keywords:
Liver cirrhosis;
Hypertension,portal;
Portasystemic shunt,transjugular intrahepatic;
Esophageal and gastric varices
- From:
Chinese Journal of Digestion
2015;(11):744-749
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with gastroesophageal variceal embolization (SEVE) in the treatment of patients with gastroesophageal varices accompanied by a gastrorenal shunt with a diameter over 5 mm .Methods From October 2013 to December 2014 ,the clinical data of 18 patients with portal hypertension caused gastroesophageal variceal bleeding and treated by TIPS combined with SEVE were collected . The difference of portosystemic pressure gradient between before and after operation was observed ,and Child‐Pugh score before and after operation was also evaluated .The hemostasis in 24 hours ,TIPS patency ,the occurrence of hepatic encephalopathy(HE) ,rebleeding ,hepatic failure ,mortality and the change of liver function and thrombocytopenia were recorded after operation .Student′s t‐test or analysis of variance was performed for statistical analysis of measurement data .Results In the 18 patients ,the average portal vein pressure decreased from (34 .23 ± 6 .35) cmH2O (1 cmH2O= 0 .098 kPa) before operation to (25 .69 ± 6 .89) cmH2O after TIPS combined with SEVE ,and the difference was statistically significant (t=7 .572 , P<0 .01) .The difference of portal vein pressure before and after operation was (8 .54 ± 4 .79) cmH2O . No hepatic failure was observed in all 18 patients .Among 10 patients with emergency operation ,nine patients obtained successful hemostasis in 24 hours .No operation related complications were observed in all the patients .During the follow‐up period of 18 patients ,two patients had variceal rebleeding confirmed by endoscopy ;one patient had stent stenosis;three patients got HE and one patient died .At different follow‐up time point of patients ,there was no significant difference in Child‐Pugh score ,blood ammonia level ,albumin level ,bilirubin level ,white blood cell count and blood platelets count compared with those before operation (all P>0 .05) .Conclusion TIPS combined with SEVE in the treatment of patients with gastroesophageal varices accompanied by a gastrorenal shunt with a diameter over 5 mm could effectively control bleeding ,and no ectopic embolism happened .
